Behavioral Health Integrator

Glossary of managed care and value based payment terms that may be useful to health centers and health center stakeholders beginning to explore this topic.

This checklist will walk you, the health center, through a series of common considerations for contracts you may receive from payers with a specific focus on contracts that include value-based payment components. This document assists organizations in understanding the necessary data and data-related tools for managing population health within a managed care environment. It is a primer on the types of best-practices that are necessary to maximize care delivery models that are responsive to value-based payment programs. Follow this checklist to further your understanding of these considerations and to help flag any outstanding issues for legal and/or consultant review prior to execution.

In this 25 minute video we cover the basic mechanics of how FQHCs are paid, the prospective payment system, and how it is evolving over time. We also review the spectrum of value-based payment arrangements using the HCP-LAN framework as a guide. We also discuss the capacity needed to be successful in each of those payment categories. Patient attribution process, including why that data is so critical in value-based payment arrangements, and what questions to ask payer partners about attribution processes are also reviewed. Lastly, a real value-based payment arrangement and related considerations are reviewed.

This HITEQ brief outlines Medicare Access and CHIP Reauthorization Act (MACRA) MACRA, what it signals for payment reform, and when it impacts health centers.